Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data (original) (raw)

Background Uptake of self-testing and self-management of oral anticoagulation has remained inconsistent, despite good evidence of their eff ectiveness. To clarify the value of self-monitoring of oral anticoagulation, we did a metaanalysis of individual patient data addressing several important gaps in the evidence, including an estimate of the eff ect on time to death, fi rst major haemorrhage, and thromboembolism. , limiting searches to randomised trials with a maximally sensitive strategy. We approached all authors of included trials and requested individual patient data: primary outcomes were time to death, fi rst major haemorrhage, and fi rst thromboembolic event. We did prespecifi ed subgroup analyses according to age, type of control-group care (anticoagulation-clinic care vs primary care), self-testing alone versus self-management, and sex. We analysed patients with mechanical heart valves or atrial fi brillation separately. We used a random-eff ect model method to calculate pooled hazard ratios and did tests for interaction and heterogeneity, and calculated a time-specifi c number needed to treat.